Application and Effectiveness of the Perioperative Position Management Based on the ADDIE Model in Patients With Congenital Microtia
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Congenital Microtia
- Sponsor
- Eye & ENT Hospital of Fudan University
- Enrollment
- 196
- Locations
- 1
- Primary Endpoint
- Ear Reconstruction Effectiveness Scale
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Aims and objectives: To evaluate the clinical application and effectiveness of a perioperative position management program constructed using the ADDIE model for patients with congenital microtia.
Background: The primary challenge in auricular reconstruction is the fragility of the reconstructed ear structure, necessitating strict avoidance of postoperative pressure to ensure the surgery's effect. Clinically, this has been found to cause anxiety in patients and their families. Some patients maintain a fixed position to avoid pressure on the reconstructed ear, which may lead to restricted neck movement and a high risk of pressure-related injuries. Therefore, a systematic perioperative position management program for patients with congenital microtia is necessary.
Methods: A quasi-trial design with non-randomized grouping was adopted. Using convenience sampling, 98 patients with congenital microtia admitted to a tertiary specialized hospital in Shanghai from May to August 2023 were included in the control group and received routine care. From September to December 2023, another 98 patients were included in the intervention group, receiving a perioperative position management program in addition to routine care. Effectiveness was evaluated using the Ear Reconstruction Effectiveness Scale, SCARED, Quality of Life Scale for Congenital External and Middle Ear Malformation Patients, SAS, Northwick Park Neck Pain Questionnaire, and Position Execution Checklist.
Detailed Description
Auricular reconstruction remains one of the most challenging surgeries due to its delicate structures and potential complications. The reconstructed auricle is too fragile to withstand excessive pressure that will cause blood circulation disturbances or even necrosis. Clinical observations have noted that patients and their families often experience anxiety due to concerns over complications and the impact on recovery, affecting their quality of life. Furthermore, patients frequently hold their heads in a fixed position to prevent pressure on the reconstructed auricle, which results in neck stiffness, asymmetry, and limited mobility. Therefore, effective perioperative position management is crucial for improving surgical outcomes and patient prognosis and alleviating negative emotions in patients and their families. In our study, we evaluated the clinical usefulness of a perioperative position management program designed using the ADDIE model for patients with microtia. The patients were divided into the experimental group（98 cases）and control group （98 cases）in a quasi-experimental design that used non-randomized grouping. The experimental group received the perioperative position management program in addition to routine care. Key elements included perioperative postural management, preoperative sleeping posture adaptability training, neck movement training, standardization of head position angles and head suspension time during surgery, use of protective headrests, attention to transfer and handover procedures, and specially designed pillows.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Diagnosis of congenital microtia according to the "Chinese Plastic Surgery" criteria, and undergoing ear reconstruction.
- •No other severe comorbidities.
Exclusion Criteria
- •Abnormal coagulation function.
- •Presence of eczema or infection on the affected side.
- •Severe cognitive impairment or mental illness.
- •Patient or family disagrees with the study.
Outcomes
Primary Outcomes
Ear Reconstruction Effectiveness Scale
Time Frame: 3 months postoperatively.
Evaluation was conducted using the surgical outcome scoring system developed by Wei Lü. The scale includes five aspects: (1) The size, position, and realism of the reconstructed ear compared to the healthy side (total score 24 points). (2) The angle size and stability of the cranioauricular angle of the reconstructed ear (total score 12 points). (3) The color of the skin of the reconstructed ear and its coordination with the surrounding skin (total score 10 points). (4) The condition of the local scars at the incision behind the ear (total score 9 points). (5) The presentation of the subunit structure of the reconstructed ear (total score 45 points). A total score greater than 85 is rated as excellent; 75-84 is rated as good; 65-74 is rated as fair; and less than 65 is rated as poor. The specific method of use involves plastic surgeons scoring based on the structure of the child's healthy side or the structure of a normal person's auricle.
Incidence of skin and flap-related complications after ear reconstruction
Time Frame: 3 months postoperatively.
The researchers independently designed the position execution checklist based on a review of relevant literature. The checklist consists of two parts: (1) Demographic Information: This includes gender, age, education level, and caregivers. (2)Disease-Related Information: This includes the duration of surgery, the side of the surgery, the name of the surgery, instances of reconstructed ear compression, the time period during which the compression occurred, the occurrence of complications, and medication usage.
Secondary Outcomes
- Quality of Life Scale for Congenital External and Middle Ear Malformation Patients(Within 24 hours prior to discharge.)
- Screen for Child Anxiety Related Emotional Disorders (SCARED)(Within 24 hours prior to discharge.)
- Northwick Park Neck Pain Questionnaire (NPQ)(Within 24 hours prior to discharge.)
- Self-Rating Anxiety Scale (SAS)(Within 24 hours prior to discharge.)